• Pathologic complete response (pCR) at the time of surgery [ Designated as safety issue: No ]
  
• Incidence of serious adverse events [ Designated as safety issue: Yes ]
  

• Evaluation of dynamic contrast-enhanced magnetic resonance imaging in assessing pCR at baseline, after course 2 of neoadjuvant therapy, and after completion of neoadjuvant therapy (prior to definitive surgery) [ Designated as safety issue: No ]
  
• Overall expression of LZTS1 as assessed by immunohistochemistry before and after neoadjuvant therapy [ Designated as safety issue: No ]
  

OBJECTIVES:

Primary

• To determine the complete pathological response (pCR) in the breast/axillary lymph nodes in women with stage II or III breast cancer treated with neoadjuvant therapy comprising paclitaxel albumin-stabilized nanoparticle formulation, carboplatin, and bevacizumab followed by surgery and adjuvant bevacizumab.
• To determine the side effects of this regimen in these patients.

Secondary

• To evaluate dynamic contrast-enhanced magnetic resonance imaging in assessing pCR.
• To measure LZTS1 gene expression before and after neoadjuvant therapy to evaluate whether LZTS1 gene expression correlates with pCR.
• To evaluate the feasibility and toxicity of adjuvant bevacizumab when administered for 6 months.

OUTLINE:

• Neoadjuvant therapy: Patients receive paclitaxel albumin-stabilized nanoparticle formulation IV over 30 minutes and carboplatin IV over 30 minutes on days 1, 8, and 15 and bevacizumab IV over 30-90 minutes on days 1 and 15. Treatment repeats every 28 days for 5 courses. After completion of course 5, patients receive paclitaxel albumin-stabilized nanoparticle formulation IV over 30 minutes and carboplatin IV over 30 minutes on days 1, 8, and 15. Patients then proceed to surgery.
• Surgery: Approximately 4-5 weeks after completion of neoadjuvant therapy, patients undergo definitive surgery (either lumpectomy or mastectomy). Patients with node-positive disease or inflammatory breast cancer at baseline also undergo axillary lymph node dissection. Patients then proceed to adjuvant therapy.
• Adjuvant therapy: Beginning approximately 6 weeks after surgery, patients receive bevacizumab IV over 30-90 minutes once every 3 weeks for 6 months. Patients with hormone receptor-positive disease also receive endocrine therapy. Patients may also receive additional adjuvant chemotherapy or radiotherapy at the discretion of the treating physician.

Patients undergo dynamic contrast-enhanced magnetic resonance imaging at baseline, after course 2 of neoadjuvant therapy, and after completion of neoadjuvant therapy (prior to definitive surgery) for assessment of tumor response. Tumor tissue is collected at baseline and during surgery for correlative laboratory studies. LZST1 gene expression is assessed by immunohistochemistry before and after neoadjuvant therapy.

DISEASE CHARACTERISTICS:

• Histologically confirmed breast cancer

  • Clinical stage II or III disease
• Clinically or radiographically measurable residual tumor after core biopsy
• No HER2/neu overexpression (i.e., 3+ by immunohistochemistry [IHC] or positive by fluorescence in situ hybridization [FISH])
• Hormone receptor status not specified

PATIENT CHARACTERISTICS:

• Menopausal status not specified
• ECOG performance status 0-1
• Absolute neutrophil count ≥ 1,500/mm³
• Hemoglobin ≥ 9 g/dL
• Platelet count ≥ 100,000/ mm³
• Creatinine ≤ 1.5 times upper limit of normal (ULN)
• Urine protein:creatinine ratio < 1.0
• AST and ALT ≤ 2.5 times ULN
• Alkaline phosphatase ≤ 2.5 times ULN
• Bilirubin normal
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception
• LVEF normal by echocardiogram or MUGA
• No peripheral neuropathy ≥ grade 2
• No history of unstable angina or myocardial infarction within the past 12 months
• No history of gastrointestinal bleeding
• No recent hemoptysis
• No known hepatitis B or HIV seropositivity
• No inadequately controlled hypertension, defined as systolic blood pressure (BP) > 150 mm Hg and/or diastolic BP > 100 mm Hg despite antihypertensive medications
• No history of hypertensive crisis or hypertensive encephalopathy
• No New York Heart Association class II-IV congestive heart failure
• No history of stroke or transient ischemic attack at any time
• No significant vascular disease (e.g., aortic aneurysm or aortic dissection)
• No symptomatic peripheral vascular disease
• No evidence of bleeding diathesis or coagulopathy
• No significant traumatic injury within the past 28 days
• No history of abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within the past 6 months
• No serious, non-healing wound, ulcer, or bone fracture
• No known hypersensitivity to any component of bevacizumab

PRIOR CONCURRENT THERAPY:

• No prior treatment for breast cancer
• More than 6 months since prior anticoagulation therapy
• More than 7 days since prior core biopsy or other minor surgical procedure, excluding placement of a vascular access device
• More than 28 days since prior major surgical procedure, including open surgical biopsy
• No other concurrent major surgical procedure